What do Medicare Prescription Drug Plans Cover?

Everyone on Medicare must choose whether they want drug coverage or not.  Even if you don’t use any prescription drugs, you should consider acquiring Medicare drug coverage to help cut your drug expenses now and safeguard against future needs and prescription drug rising costs. If you’re new to Medicare but already have other drug coverage, you have some new alternatives to think about. If you’re not new to Medicare, take a look at your choices to see if you can select drug coverage that better fits your needs.

Two Prerequisites to Obtain Medicare Prescription Drug Coverage

In order to qualify for prescription drug coverage, you must be enrolled in a Medicare program.  The original Medicare program offered by the U.S. Government has Parts A and B.  Inpatient hospital stays, skilled nursing facility care, hospice care, and certain home health care are all covered in Part A of the Medicare Program. Part B of Medicare provides some doctor’s services, outpatient treatment, medical supplies, and preventive services. It does not cover medicine.

The Medicare Prescription Drug Plan?

Everybody with Medicare can obtain prescription drug insurance coverage. If you don’t join a Medicare Prescription Drug Plan (Part D) when you first become eligible and don’t have any creditable prescription drug coverage or Extra Help, you can still apply for this coverage at a later date, but Medicare will charge a late enrollment penalty.

Two Options for Obtaining Drug Coverage

  • A Medicare Prescription Drug Plan.
  • A Medicare Advantage Plan (Part C), such as an HMO or PPO, or another Medicare health plan that provides coverage for prescription drugs.

To acquire Medicare prescription coverage, you must enroll in the original Medicare-approved plan or an approved plan offered by an insurance company or another private firm. The price and drugs covered by each plan may vary.

Do I Need a Medicare Drug Plan?

Before turning 65, you should look into your health care insurance to fully learn about its medical and drug coverage and costs as it may influence your choice to enroll in the Medicare drug coverage plan. Some forms of insurance provide prescription drug coverage that resembles Medicare and maybe worth keeping rather than enrolling in a Medicare drug plan. The following are some examples:

  • Federal Employee Health Benefits (FEHB) programs
  • Veterans’ Benefits

The above insurance policies are known as “creditable.” If you decide to join up for a Medicare drug plan in the future, you can keep them and avoid incurring a Medicare penalty.  If you don’t join when you’re initially eligible, Medicare may impose a penalty on your monthly payment. Many health plans supplied by employers and unions may also qualify as being creditable.

How is Medicare Coverage Organized?

If you decide you need Medicare drug coverage, it’s important to understand how the prescription drug portion of the program works into the wider scheme. Medicare is a government health-insurance program for adults 65 and above, as well as younger people with certain impairments and those with end-stage renal illness (kidney failure). Medicare divides into sections that provide different kinds of coverage that are categorized as Parts:

  • A – Includes inpatient hospital stays, skilled nursing facility care, hospice care, and certain home healthcare.
  • B – Includes some doctor’s services, outpatient treatment, medical supplies, and screenings and immunizations, among other things.
  • C – Medicare Advantage covers Parts A and B, as well as Part D. HMOs and PPOs, for example, are private health insurance firms that provide these plans.
  • D – The prescription drug coverage add-on to Medicare.

How do I Obtain Coverage?

Medicare enrollees can obtain prescription drug coverage in two ways:

  • Original Medicare (Parts A, B, or both) and special plans like Medicare Cost Plans, Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans can all contain prescription drug coverage. Part D, usually known as a prescription drug plan or PDP, covers you if you go this route.
  • It’s available as part of a Medicare Advantage Plan or another Medicare plan that includes prescription drug coverage (also known as an MA-PD). During open enrollment, you can move from a Medicare Advantage Plan that does not provide prescription drug coverage to one that does.

What will my Plan Cover?

Prescription drugs picked up at the pharmacy are covered by your Medicare prescription drug coverage plan. For example, it won’t cover drugs given to you by a doctor during a hospital stay or in an outpatient hospital environment.  It also excludes over-the-counter medicines like ibuprofen and Sudafed. However, it will cover certain drugs like insulin.

The Cost of Drugs Covered by Medicare

The cost of a Medicare prescription drug coverage includes a variety of factors including:

  • The premiums and cost-sharing that come with your plan.
  • The extent of your insurance.
  • The pharmacy that you go to.
  • Whether you reach the coverage gap, often known as the “donut hole.”
  • Whether or not you choose Medicare’s Extra Help program.

Let’s take a look at each one separately.

Cost-sharing and premiums

The majority of plans will demand that you pay a portion of your prescription drug costs (known as cost-sharing). Deductibles, coinsurance, and copays are all examples of cost-sharing. You will pay premiums as well. These expenses will differ depending on the plan.

  • A deductible pertains to an amount you pay for prescription drugs before your insurance kicks in (not all plans have deductibles).
  • After you’ve reached your deductible, you’ll pay coinsurance — a portion of prescription drug costs.
  • After you’ve reached your deductible, you’ll have to pay a copay for drugs.
  • The insured pays a monthly premium for prescription drug insurance.

Consider how much you can afford to spend for each prescription, as well as the overall expenses and coverage when picking a prescription drug plan. A plan’s premiums or deductibles may be costlier, but after you’ve reached the deductible, it usually provides enough coverage. The projected monthly Part D premiums by income are included in a table on the Medicare website. You must pay a monthly adjustment in addition to your premium if your income exceeds a particular threshold.

Covered Medications

When you look at plans, make sure that the ones you consider have a formulary that contains the prescriptions you use. A formulary is a list of drugs covered by a Medicare prescription plan. When your medicine isn’t on the formulary, you should ask your doctor if a similar drug is on the list or if they can assist you to acquire a coverage exemption. Medication is also divided into levels in certain plans. In general, the higher the tier, the greater the cost of the drug. Examine your prescriptions to see where they fall.

A generic drug, as opposed to a brand-name medication, normally costs less and provides greater coverage. Finally, check to see whether your plan imposes any limitations on your prescription coverage, such as prior approvals, step treatment, or quantity limits. These limits don’t always imply you won’t be able to acquire coverage for the medication. However, it may make acquiring insurance more difficult.

Extra Help

You should also think about whether you qualify for Medicare’s Extra Help program. Medicare will help cover your drug expenses, premiums, deductibles, and coinsurance if you fulfill the program’s eligibility and income conditions.

In Conclusion

For those considering the original Medicare Health Program or the Medicare Advantage Plans, you should investigate the different choices before applying for Medicare coverage. Depending on your circumstances, other creditable healthcare insurance choices may provide a better fit.

Medicare Special Needs Plan

Special Needs Plans (SNPs) are Medicare Advantage plans for people with a low income or who suffer from specified illnesses or conditions. It’s difficult to possess a disease that needs added medical attention, and it’s much more difficult to meet healthcare bills on a limited or low income. You may qualify for a special Medicare plan — called a special needs plan (SNP) — if you have a chronic illness. Hospital stays, office visits, prescription medicines, and all other Medicare-approved services become covered under a Medicare SNP. SNPs contain prescription drug coverage; however, SNP plan availability varies by location.

Special Needs Plans come in four varieties.

  1. Dual Special Needs Plans (D-SNPs) People who possess both Medicare and Medicaid become eligible for this benefit (called “dual eligible”)
  2. Chronic Special Needs Plans (C-SNPs) For persons with chronic, severe, or debilitating illnesses
  3. Institutional Special Needs Plans (I-SNPs) For people in skilled care facilities
  4. Institutional-Equivalent Special Needs Plans (IE-SNPs) For persons who reside in a contracted assisted living facility but require the same level of care as those in a skilled nursing facility

Chronic Conditions where SNPs Apply

You might obtain an SNP if you suffer from cancer or heart problems. SNPs encompass 15 chronic diseases.  Autoimmune illnesses, diabetes, dementia, lung disease, and end-stage liver and kidney diseases are among the examples.

What do Special Needs Plans Cover?

All Medicare Advantage plans, including Medicare Part A and Part B, must cover the same healthcare services as Special Needs Plans do. Some SNPs may additionally cover other services customized to the unique demographic they need to help; nevertheless, all Special Needs Plans must cover prescription drugs. You should carefully research each plan you could qualify for to see exactly what benefits and services get covered.

Who Should Get a Medicare SNP?

If you qualify and meet the following criteria, a Medicare SNP plan could definitely help with your medical care:

  • You suffer from a long-term health problem that necessitates many drugs and regular medical intervention. Targeted, coordinated health care provides great benefits for patients.
  • You spend at least 90 days in a facility because you require medical attention that you cannot obtain at home. For skilled home care services, you may receive extra coverage.
  • Medicare and Medicaid insurance plans are available to those that qualify. A patient strategy will ensure that their providers accept Medicare and Medicaid.

Medicare SNP Costs

Your out-of-pocket expenses will depend on how frequently you require care and what sort of care you require. It makes a difference whether you go to doctors in your SNP’s network or not. The following are important facts to know:

  • If you qualify for both Medicare and Medicaid, or if you maintain a low income, you can get care at a lower cost.
  • Your expenses may vary based on the SNP you select, but they will compare to Medicare Advantage plan rates.

Special Needs Plan Limitations

These plans must offer the same service options, coverage, benefits, safeguards, and rights as Original Medicare. SNPs, on the other hand, might set their own set of rules, prices, and limitations. Recipients of health care and services from inside the SNP’s network may be subject to certain restrictions. However, sudden illnesses that necessitate emergency room or urgent care services, or if a beneficiary suffers from End-Stage Renal Disease (ESRD) that necessitates dialysis outside of the service region, there are certain exceptions to the rules. Beneficiaries must seek health care from an in-network primary care physician or a care coordinator under these plans. Referrals to SNPs network specialists are frequently necessary. On the other hand, some services or experts, such as yearly mammography screenings and pap tests/pelvic checks, may not require a formal referral.

Benefits of a Medicare SNP

A Medicare Special Needs Plan (SNP) combines hospital, medical, and prescription medication coverage into one package. This makes it easy to organize all aspects of your treatment, as well as follow your doctor’s diet and pharmaceutical recommendations. It may also assist you in obtaining community assistance. A single healthcare plan covers all of your medical needs. It’s critical to double-check that your SNP plan covers the services you require once you’ve registered in one. If you’re unsure, you can request a decision from the plan ahead of time to ensure approval of the service.

A Medicare SNP can assist everyone in need. Your benefits, physicians, and prescription coverage are all tailored to your unique requirements with an SNP. Your SNP may provide unique services to manage care for persons with congestive heart failure if you have it. It may also assist you in locating doctors that specialize in the treatment of this condition.

An SNP will assign a care coordinator. This individual ensures that you receive the preventative care and treatments that you require in order to maintain your health. Your care coordinator can help you find community services that will be beneficial to you.

A Medicare SNP can Coordinate Medicare and Medicaid plans.

You won’t need extra drug coverage as SNPs cover drugs.  This means that people with SNP do not need Medicare Part D, which covers prescription drugs.

You will not need other health insurance like a Medicare supplementary insurance plan because an SNP will cover the costs.  Also, Medigap does not function with Medicare SNPs, because SNPs will handle your premiums, deductibles, and co-payments. Additional services that may be duplicated by Medigap, like extra days in the hospital, are frequently covered by Medicare SNPs. It’s crucial to compare the advantages of both plans to ensure you’re not overpaying for additional coverage you don’t require.

How Do I Enroll in a Medicare SNP?

Like all alternative health care Advantage plans, you want to be registered in elements A and B of health care and may enroll throughout the Annual Enrollment Period (AEP) or modify your present SNP through the health care Advantage Open Enrollment period (MA-OEP). However, owing to the character of SNPs, you’ll be approved if you qualify by having a severe, disabling, or chronic condition, or by developing the necessity for or being admitted to a nursing home-level of care for a minimum of ninety days.

The following are the Medicare Advantage Plan enrollment periods. A Special Enrollment Period becomes available if you are no longer eligible for an SNP and must enroll in another plan (SEP).

  • Initial Enrollment Period (IEP): This seven-month period begins three months before your 65th birthday month, continues for three months following your birthday month, and concludes three months after your birthday month.
  • Initial Coverage Enrollment Period (ICEP): This period allows those who desire to enroll in a Medicare Advantage Plan can do so, and it frequently coincides with the IEP for Original Medicare.
  • Annual Enrollment Period: The dates for this event are October 15th through December 7th.
  • Medicare Advantage Open Enrollment: Between January 1st and March 31st, Medicare beneficiaries who are currently enrolled in a Medicare Advantage Plan can change plans.

What does it mean if my Prescription Drug has a Limitation?

When an insurance company provides coverage for a certain medication, it may impose conditions or limitations on the coverage. “Cost utilization measures” refers to a term used to describe these prescription medication limitations. Individual prescriptions, rather than the entire formulary of the insurance plan, are usually subject to prescription drug restrictions.

The following identify the three main categories of drug limits:

  • Quantity Limits
  • Prior Authorization
  • Step Therapy

Quality Limits

Taking too much medicine or taking it too frequently might aggravate your health and cause you to see specialists, buy more medicine, and therefore, raise your healthcare bills. Because of this, private health insurance companies that provide prescription medicine coverage may impose quantity restrictions. When a covered drug has a quantity restriction, the plan will only pay for a certain amount of the medication for a certain amount of time. The plan may, for example, limit coverage of certain prescription medicine to 30 pills each 30-day period.

The insurance company will not pay your prescription medication costs if you attempt to refill a prescription many days before the 30-day period expires or if your doctor recommends a larger quantity than the maximum recommended. The total quantity of prescription drugs that a pharmacy can deliver at one time depends on the Insurance Health Plan. This sort of restriction is rarely a substantial impediment to patient access. These restrictions ensure that a patient does not obtain more medicine than is recommended by best practices or medical recommendations.

Prior Authorization

Prior authorization, also known as preauthorization or prior approval, requires a doctor or patient to first obtain permission from the health plan before being covered for a certain prescription medicine. Obtaining prior approval verifies that the prescription medicine falls under the category of “medically essential”. Also, the approval will confirm that the regime follows best practices and the medical criteria for treating the patient’s condition. For all or almost all high-cost specialty drugs, many plans demand prior permission. Some drugs cost more and have more adverse effects than others, while others may have time limits on how long the drug may be used. Some plans demand prior authorization to ensure that certain drugs are used properly.

This process requires a prescribing doctor or pharmacist to first obtain permission for a medication’s coverage. The pre-authorization procedure allows the prescribing physician and the plan’s clinical staff to share information on the health condition that the prescription medicine treats, as well as other drugs often used to treat the condition, if appropriate. If your insurance company needs prior permission for a certain drug and you do not obtain it before getting your prescription filled, the pharmacy will charge you for the full retail price of the medication.

Step Therapy

Step therapy refers to prescription drug restrictions in which less costly drugs must prove that they do not work for a beneficiary’s medical condition before a more expensive medication for the same ailment becomes covered. This program was created for those who need to take drugs on a regular basis. For example, drugs taken for high blood pressure and high cholesterol. Prescription medications are divided into two groups in Step therapy: front-line drugs and backup meds, according to their cost.

Patients must first take a lower-cost medicine for a period of time before getting coverage for a higher-cost prescription under step therapy. Because the patient and physician must establish that a lower-cost drug does not work before covering a higher-cost prescription, this practice refers to “fail first.” Step treatment does not generally refer to anti-cancer drugs at the moment, although it focuses on pain meds.

Front-line drugs are generic, low-cost medications that doctors initially prescribe.  These drugs usually deliver the same therapeutic advantages as the more expensive brand-name treatments. The formulary of the plan can vary from year to year, which means that a prescription medicine you use for one year may have one or more of these limits, but not the following. If a change impacts you, your plan will notify you. In addition, your plan will notify you of benefit changes in the autumn through a mailing that contains the plan’s Annual Notice of Changes and Evidence of Coverage paperwork.

Prescription Drug Utilization Management

Utilization management refers to a term used by health insurers to describe a set of treatments and cost-cutting measures. In its prescription drug benefit, health plans typically use usage control approaches, especially for high-cost specialty drugs. Because many cancer therapies are classified as specialty tiers, cancer patients may need to meet usage control standards prior to receiving drug prescriptions. Step treatment, prior authorization, quantity limitations, and mandated generic substitution are all common prescription drug use control methods.

Mandatory Generic Substitution

When a patient chooses a brand-name medicine over a generic counterpart, some health plans require the patient to pay the cost difference between the generic and brand-name drug in addition to the brand-name drug’s standard cost-sharing. When generic drugs are available, this usage management method aggressively encourages their use. Upon a plan adopting forced generic replacement, it usually does so across the board, not only for certain medications.


10 ways to save on health care

According to the Centers for Medicare and Medicaid Services, healthcare expenditures are a considerable expense. In the United States, insurance costs an average American family $12,530 each year. The typical household brings home slightly over $67,000 in income but many households bring home considerably less than that. Thus, insurance remains a significant portion of a monthly family’s budget.

The COVID-19 pandemic’s impact on the job market has been substantially negative. With the loss of jobs and the benefits of employer health insurance, millions of people no longer have healthcare insurance coverage.  People are now looking for other solutions to meet medical bills, and are seeing how difficult it is to navigate the health care system.  This is a daily task for those with chronic diseases and long-term treatment demands. However, if you know where to search you can find ways to save a lot of money on healthcare.

According to medical professionals, the following 10 methods will save money on your healthcare:

Evaluate your Current Insurance Plan

So, are you getting the most bang for your buck with your insurance policy? Since many of your healthcare-related charges are determined by your plan, you should examine them and understand what’s covered and what’s not covered. That entails learning how much your copay and/or coinsurance costs. Determine your deductible cost, and which doctors, clinics, and hospitals are in-network. Also, familiarize yourself with the prescription formulary covered by your plan. You can work with your doctor to see if your medicines can be changed. A different medicine may fall into a lower pricing tier of your insurance plan.

Save Money on your Medicines by Looking for Methods to Cut Costs

Register for a pharmacy discount card. Pharmacy savings cards are no-cost programs. These cards can provide substantial reductions in medicine prices when purchased at the pharmacy counter. You may evaluate different programs to compare pricing for your medication. Simply present your card to the pharmacist to receive discounts on your medicines. Furthermore, certain pharmacies, such as Walgreens and Walmart, provide prescription savings programs you can sign up for.

When possible, request generic drugs. Your doctor may not automatically prescribe the least expensive medicine. Doctors frequently prescribe the name-brand medications with which they are most familiar. Generic medications, on the other hand, are just as effective as brand-name medicines. Often, generic medication can cost 80 percent to 85 percent less. Always check with your pharmacist to see if you are getting a generic version.

Think about changing your medications to be sent via mail. Opting for a mail-order pharmacy may save you money. And if you use the same medications regularly, you can also select autofill. Mail-order pharmacies let you fill your prescriptions in bulk. This allows the patient to receive a 90-day supply rather than a 30-day supply. Ordering your prescriptions this way typically results in significant savings.

Always Shop Around

If you have high healthcare costs, you should investigate your choices. Many consumers are unaware that some surgeries can be done at a surgery center. And it could cost tens of thousands of dollars less than a hospital surgery. Each facility has different charges, so ask your doctor for a more reasonable option. Patients can get surgery estimates for operations by calling hospitals ahead of time. Before making doctor appointments, many insurance plans enable you to search for in-network providers. Some hospitals and insurers even provide real-time pricing estimates using internet platforms.

Avoid Unnecessary Healthcare Expenses

Be open and honest with yourself about any financial obstacles you may experience. Evaluate your treatment plans and prescriptions. Identifying your financial constraints will help you focus on the questions you should ask. Ask your insurance company and your healthcare provider about how to find lower-cost options. Finally, consider what type of test, medication, or operation has been prescribed and make sure they are indeed necessary. Also, ask for a more reasonably priced solution that will work for you.

Do Not Hesitate to Negotiate Costs

Despite appearances, many huge hospital bills are negotiable. Waivers, monetary reductions, and relief plans are available at many hospitals. Call the billing department and see if there are any healthcare savings available. You can also ask if any connected expenses may be waived. The billing department will also have information on how to set up an interest-free payment plan.

Use Free Resources to your Advantage

Certain health tests may be available for free or on a sliding scale. Some community clinics and many large corporations have programs that allow you to receive treatment at no cost.

Preventive services can help lower health costs. If you have health insurance, many plans include a free yearly checkup. For example, annual physicals and well-woman exams are covered with no payment. Check with your insurance provider to determine whether you qualify for this benefit.

For instance, insulin treatment could be more reasonably priced. According to the American Diabetes Association, 37.3 million Americans have diabetes. It is no surprise that many individuals with diabetes are struggling to pay for their treatment as the costs continue to grow. However, in recent years, pharmaceutical companies have launched programs that offer free or low-cost insulin. Insulin assistance programs like coupons are available online from several manufacturers. You can also contact them directly to see if they can help by locating the corporate phone number online. In addition to these initiatives, discount pharmacy cards can assist diabetics to lower the costs of prescriptions. Also, they can help locate the drugstore that offers the most reasonable insulin prescription pricing.

Contrary to common belief, economical vaccines are not usually available at community health clinics. Both uninsured and underinsured people can get free or reduced-cost immunizations from local health centers and state health agencies. Manufacturers of vaccines provide payment assistance for both children and adults. You must shop around and find the ideal choice for you. This will help you save as well.

Sign Up for an HSA or an FSA Account

Firstly, if you have health insurance, see if you have an HSA or FSA option. HSA (health savings account) or an FSA (flexible spending account) can help you save money. It could also help with your out-of-pocket medical expenses. Both accounts enable you to set aside a percentage of your pre-tax income. This will pay for eligible medical expenditures such as copays, coinsurance, medications, and more.

Get Appropriate Care

It’s tempting to go to the first care facility that has an appointment available. Especially, when you’re sick. However, not all supplier choices are equal in price. Do you need to go to the ER or urgent care facility? Or can you wait for an appointment with your primary care physician or a clinician in your network? Depending on the type of condition and the urgency, there are many options to choose from. These options offer a wide range of patient responsibilities, including copays and deductibles. So, the right option may save you hundreds of dollars.

Examine your Medical Bills for any Mistakes

When you get a huge medical bill, there are certain procedures you should follow. To begin, make certain you receive an itemized receipt with each product listed separately. It should include the expenses broken out for each item.  Compare your bills, both the treatments listed and their charges with your health insurance’s explanation of benefits (EOB). Review it item by item. If you discover an inaccuracy, contact your insurance company, and file an appeal. You can also contact your doctor’s office for help. You can contact who billed you and inquire about your charges. To appeal is easy. Also, keep all your bills and receipts along with a copy of any payments.

Practice Preventive Care

Finally, establish a daily health and wellness regimen that works for you. This can certainly help reduce your long-term healthcare bills. A good diet, regular exercise, and stress management will help to stabilize a person’s health. When you have all three of these working for you. You will have a really good recipe for your health. Staying hydrated, going for a daily walk, stopping smoking, and drinking less alcohol, will catapult you into great health. These changes can have a significant influence on your future health. And save you lots of money on medical bills.

These approaches are excellent for reducing your day-to-day healthcare expenses. There’s no reason to spend more on your healthcare than is required. Regardless of your insurance coverage, you must diligently manage your healthcare.



Affordable Care Act (ACA)

Affordable Care Act (ACA)

The Affordable Care Act (ACA) law was signed in March 2010 by President Barack Obama and was designed as a healthcare reform bill for the United States. The Patient Protection and Affordable Care Act, or Obama Care, implemented a set of healthcare regulations aimed at increasing access to health insurance for millions of uninsured Americans.

The law increased Medicaid eligibility and established health insurance exchanges to permit and require Americans to purchase Health Insurance if they had no health insurance. It also prevented insurance companies from rejecting coverage (or charging extra) because of pre-existing conditions. In addition, the law permitted children to remain on their parent’s health insurance plan until they become 26 years old.

An Overview (ACA)

As mentioned previously, the ACA was designed to provide insurance coverage for people who were not insured, but met certain qualifications. Because the law provided tax credits and cost-sharing reductions, it assisted lower-income individuals and families so that they could afford health insurance.  The savings were from the tax credits that reduced the overall monthly health insurance costs, and the law decreased some of the associated costs of insurance including, cost-sharing reductions, out-of-pocket payments, deductibles, copays, and coinsurance.

All ACA-compliant plans, must cover certain essential health benefits, such as:

  • Ambulatory patient services
  • Breastfeeding
  • Emergency services
  • Family planning
  • Hospitalization
  • Laboratory services
  • Services for psychological state and substance abuse disorders.
  • Maternity, neonatal care, and pregnancy
  • Prescription medications
  • Chronic illness management, as well as preventive and wellness programs
  • Pediatric services
  • Service for rehabilitative purposes.

In addition, it mandates that most insurance plans include a list of free preventative care measures. These consist of check-ups, patient consultations, immunizations, and a range of health tests. It also permitted states that opted-in to cover a broader group of patients under Medicaid. That option has been adopted by 37 states and the District of Columbia as of June 2021.

Each year the healthcare marketplace opens an enrollment period during which customers can purchase or transfer insurance policies. If you miss this deadline, enrollment will be delayed until the following year. Exceptions due to marriage, divorce, having a child, or leaving a job that provides health care coverage permit enrollment outside the open period.

Improving the Quality, Efficiency, and Accountability of Healthcare Services

By enacting broad changes, Medicare and Medicaid payments changed. These new payment options and service delivery models included a new spectrum of ideas. Some of them paid for medical devices, clinically integrated & accountable care organizations, and allowed episode-based and bundled payments.

These modifications were meant to allow public payers to encourage the healthcare system to behave differently. This included terms of how health professionals were to work in a much more clinically integrated fashion. These changes affected how they monitor and report on the reliability of their care. Also, the law targeted serious and chronic health conditions and implemented monitoring hospital admissions and readmissions in order to find methods to improve the quality of care.

Improving Public Health and the Training of Health Professionals.

The Act also focuses additional public health and healthcare spending on certain subpopulations. These populations receive special attention targeted at enhancing the performance of health and healthcare programs. School-based health centers, dental health-care preventative activities, tobacco cessation programs for Medicaid-enrolled pregnant women, and the inclusion of individualized Medicare healthcare prevention planning received new funding. In addition, the Act permits significant investments in primary care health professional training.

Except for additional expenditures in teaching health centers, all changes were approved but not financed as part of the Act, and therefore, require separate budgeted funds.

The Affordable Care Act Necessitates Rapid Changes

Anyone who acquired a health insurance plan by March 23, 2010, maintained a
“grandfathered” plan. The grandfather clause guaranteed that current plans would continue as long as their insurer stayed in business.

After March 23, 2010, anybody who purchased health insurance would need to enroll in a new plan that fulfilled all of the Affordable Care Act’s new requirements.  The original deadline for this shift was January 1, 2014, or the renewal date of a plan during the 2014 plan year.

After 90 days, the Affordable Care Act required implementing the following changes.

  • June 23, 2010:
    • Tax credits of up to 35 percent of premiums were available to some small enterprises.
    • A total of $5 billion was set aside for people who were unable to obtain insurance.  Instead, they were able to purchase insurance from the government with these amounts.
    • A temporary reinsurance scheme was created to pay employers for a portion of the expense of providing health insurance coverage to early retirees.


  • July 1, 2010:
    • The Pre-Existing Condition Insurance Plan (PCIP) was created to provide health insurance to those who had been denied coverage by private insurers due to a pre-
      existing condition.


  • September 14, 2010
    • A list of frequently asked questions published by eHealth, along with a timeframe for the implementation of major improvements. Remember that several of these elements changed throughout the implementation of the Affordable Care Act.

After 180 days, the Affordable Care Act required the following changes:

  • September 23, 2010:
    • To overcome the Medicare Part D coverage gap, seniors can receive a $250 reimbursement.
    • People may search for information on health insurance firms, available plans, and other important details on a government website.
    • Pre-existing conditions cannot be excluded from coverage for children by insurers.


  • October 19, 2010:
    • eHealth publishes the first in a series of materials to assist uninsured children in navigating state disparities.

In summation, the Affordable Care Act caused a major change in America’s healthcare.  Each year challenges occur, but they become nullified by the continued advancements in public health policy and practice. The Act provides reformed healthcare coverage and care, but also considers public health’s essential role to provide its citizens with universal health coverage.

What the ACA Means for You

The Affordable Care Act, which covers a large percentage of Americans, is possibly the most significant transformation of the US healthcare system yet. In addition, one of its significant innovations is the inclusion of health coverage for persons with pre-existing diseases, which previously did not universally exist. These significant changes in healthcare insurance have become beneficial to individuals and families across the nation.

With all of the good things said about the HCA, there are lots of other Health Insurance Companies.  These other Health Insurance Companies offer customized Health Insurance.  Finding the best insurance at the best price for an individual or family is still necessary to guarantee that you and your family receive great healthcare insurance at an affordable cost.

Criticizing the Affordable Care Act 

The Affordable Care Act (ACA) was criticized by many as an unprecedented extension of federal authority in the healthcare business. The reason:  it obligated everyone to acquire health insurance — whether they wanted to or not. This side of the law was a serious focus of dialogue, and it was challenged within the U.S. Supreme Court in 2012 by the National Federation of freelance Business. The court upheld the individual mandate as a constitutional use of Congress’s taxing authority, classifying the fines imposed on the uninsured as a tax.

Today, the Affordable Care Health Insurance Plan does not work for everyone, and is known as only one of the many health insurance plans available to all.  We invite you to learn more about Health Insurance for you and your family.  Our experts can help you select an affordable great plan that will pay the doctor and hospital in case you or a family member needs coverage.



Medicare vs. Medicaid: Do You Qualify for BOTH?

Just when you think that Medicare itself cannot get any more confusing, it does. But, for some Americans, it becomes more confusing in a positive way. For many Americans who are close to retirement and qualify for Medicaid health assistance, the question about whether they will also qualify for Medicare health insurance is one they’re likely to consider, especially if they don’t have the answer. And if it’s still a question you have, you can rest easy knowing that it will be answered by the end of this article.

This article is intended to answer your question about whether you qualify for both Medicare and Medicaid, what each is, how you can qualify for the two services and what their overall differences are.

Let’s get into it by first understanding what the two programs are.

What is Medicare?

If you’re familiar with The Best Senior Services’ website and blogs, then you’re probably familiar with the available Medicare plans out there. But for those who are new here and wanting to learn more about the program, Medicare is a health insurance program that covers Americans who are at least 65 years old.

There are four parts to Medicare: Parts A, B, C and D:

  • Medicare Part A covers hospital insurance. This means that your in-patient hospital stays will receive some coverage from Medicare. For many enrollees, Part A is provided at no additional cost.
  • Medicare Part B covers medical insurance. This means that your out-patient medical visits to doctor’s offices will receive some coverage from Medicare. Part B is paid for through monthly premiums that enrollees will receive. The premium costs will vary based on your income.
  • Medicare Part C is a Medicare Advantage plan. A Medicare Advantage plan is an alternative plan to the Original Government Medicare (OGM) plan. It is sold through private insurance companies that have been verified through Medicare, and is known for providing more coverage than the OGM plan.
  • Medicare Part D covers drug prescriptions. This is optional coverage, designed to help Medicare recipients pay for prescription drug costs. Part D is offered for both the OGM plan and the Medicare Advantage plan.

What is Medicaid?

Medicaid has been around since 1965, the same year Medicare was implemented. It is a federal program that helps with healthcare costs for millions of Americans, like children, pregnant women, seniors, Americans with disabilities and more. There are a few ways in which Medicaid is similar to Medicare, including how its spending is focused on helping those who are disabled and aging, as well as its coverage. Coverage that is similar to Medicare can include hospital visits, in-home care, doctor’s visits, wellness screenings, medical transportation and more. Additional benefits can include hospice, speech therapy, physical and occupational therapy, prescription drug coverage, personal care and more.

Medicaid is a joint program, meaning it’s funded both by the federal government and by your state’s government. Medicaid’s joint program status means that there isn’t a limit to the amount of people who can be enrolled in Medicaid, which is a major benefit to many. And like many other programs across the nation, Medicaid is constantly evolving. As time has progressed, the eligibility margins have grown and coverage milestones have been met. Perhaps the biggest milestone it has passed is being known as one of the nation’s largest health insurers available.

Those who are enrolled with Medicaid have the option to receive their coverage through private care plans that are verified through their states. And even if you’re already enrolled in a separate, private insurance plan, that doesn’t hinder your eligibility for Medicaid. In most cases, you should still be able to qualify for the Medicaid program.

Speaking of qualifications, let’s get a better understanding of how you can qualify for both of these programs.

How do I qualify for Medicare and Medicaid programs?

Luckily for many, the qualifications outlined by Medicare and Medicaid are cut-and-dry, meaning you’ll have a great understanding of whether you’re eligible before you begin the application process. Those who are eligible for Medicare’s services typically tend to be at least 65 years old. However, you may also qualify for Medicare before the age of 65 if you have been receiving Social Security disability for 24 months, have Lou Gehrig’s disease (formally known as amyotrophic lateral sclerosis) or end-stage renal disease.

Those who have already been receiving Social Security benefits are automatically enrolled in Medicare Parts A and B upon the month they turn 65. Additional coverage options will then be made available for those who are interested. Those who need to manually enroll themselves into a Medicare program can do so through the Social Security Administration (SSA). They can enroll through the SSA website, calling 1-800-772-1213 (or 1-800-325-0778 for TTY users) or by visiting their local Social Security office.

After becoming a part of the Medicare program, enrollees can expect to receive welcome packages with their new Medicare card, also known as the Red, White & Blue Card, included. It’s important to keep this card close so that you can protect yourself from Medicare fraud, as well as those who could scam you, as many seniors fall victim to scams as it relates to Medicare.

The qualifications for Medicaid are slightly different from Medicare’s qualifications. According to Medicaid.gov, those who will be able to qualify for “mandatory eligibility groups” are low-income families as well as “qualified pregnant women and children, and individuals receiving Suppliemental Security Income (SSI).”  However, unlike Medicare, there isn’t really a way to be automatically enrolled into a Medicaid program, unless you meet certain criteria by the SSI, as outlined by the SSA. Otherwise, those who are interested in applying for Medicaid coverage can do so by visiting their state’s Medicaid agency.

Now that we understand how you can qualify and apply for both of these programs, let’s get to the really important question — are you eligible to be enrolled into both of these programs concurrently?

Can I qualify for both Medicare and Medicaid?

The short answer is: yes! If you’re qualified for Medicaid, you can qualify for Medicare, too, and vice versa. When you qualify for both programs, it’s known as having ”Dual Eligibility.” And for those with Dual Eligibility, there is a possibility that all of your healthcare costs will be covered. This means that Medicare copays and coinsurance could be handled, as well as any charges that would not be taken care of by your primary insurance carrier.

However, it’s still important to note that there are some differences between the two that you’ll need to know. The most important difference is that Medicare is an insurance program, while Medicaid is an assistance program. As a result, the qualification requirements for the two services are different, which is why we highlighted them earlier in the article. Other differences include the fact that, though Medicaid is a joint federal-state program, Medicare is solely run by the federal government. Finally, Medicare enrollees determine the amount of coverage they receive, while those covered under Medicaid’s services are covered by what their respective states provide.

Regardless of differences, though, both programs are great and intended to make sure that its members are as protected as possible.

Medicare and Medicaid are two great programs that protect everyone who is enrolled within them. And when these two programs come together, they make sure that those who are dually eligible receive great coverage. If you’re interested in learning more about Medicare, Medicaid or other financial services during your retirement, then look no further than The Best Senior Services (TBSS). We inform seniors about important topics related to their retirement and connect them with local licensed agents, so that they can spend more time enjoying their retirement instead of worrying about it.

Visit our website or call us at 855-979-8277 to get started with us today.

Medicare vs. Social Security: What YOU Need to Know

By now, you’re probably familiar with both the social Security and Medicare programs that you may be offered as you reach your retirement. These are both great financial aids for you and your older years. As you look at your options pertaining to the two of them, you may begin asking yourself what the large difference between the two is and whether having one will affect your chances of gaining the other. There are a lot of questions you have to address with insurance and financial programs, but it all starts with discovering the basics.


So, what is the difference between Social Security and Medicare?


In this article, we’re going to cover:

  • What they do for you
  • Similarities
  • How one may affect the other
  • Things to keep in mind


What they do

Medicare is a health insurance plan that is offered to seniors or those who qualify through their disability. It’s broken up into four parts that tailor to the recipient’s needs: Parts A, B, C and D. Generally, a recipient is 65 years old and has a specified period of time in which he or she can enroll in Medicare.


Social Security is a benefit program that is run by the federal government. Generally, the earliest a recipient is able to start collecting his or her Social Security benefits is at 62 years old, assuming he or she meets the other specified qualifications.


To be eligible for Social Security, you must be working and paying the Social Security taxes. Although you do not have to be a U.S. citizen to qualify for Social Security, you must work in order to earn the benefits. This is translated into having 40 credits, which you can gather as you pay the Social Security tax on your earnings. You can earn up to four credits per year, equating to 10 years’ worth of work.


To be eligible for Medicare, you must have been working long enough to be able to receive Social Security benefits. You must also be a citizen of the United States. The final qualification for Medicare doesn’t apply to everyone, but it may apply to you. You may also be eligible for Medicare if you or your spouse is a government employee who hasn’t paid into Social Security but has been paying payroll taxes for Medicare.


You may have already known about the basic functions that the two offers, but you may still be wondering about what makes the two similar. Let’s dive into that.


The similarities between Social Security and Medicare

The first similarity is one we briefly touched on earlier, and that is that the two are federally funded. It’s also important to note that the two aren’t exclusive to those who are approaching retirement age. The two programs also provide benefits to those who have disabilities.

According to the federal government, you can qualify for Medicare below the age of 65 if you:


  • Have been entitled to Social Security benefits for at least 24 months. These months do not have to be consecutive.
  • You receive a disability pension from the Railroad Retirement Board and meet certain conditions.
  • You have Lou Gehrig’s disease. This is formally known as amyotrophic lateral sclerosis.
  • You have permanent kidney failure.


According to the Social Security Administration (SSA), you can qualify for Social Security benefits as a child if you are unmarried and:


  • Younger than 18.
  • 18-19 years old and a full-time student (no higher than grade 12).
  • 18 or older that began before the age of 22.


In special cases, benefits can also be awarded to stepchildren, grandchildren, step-grandchildren or adopted children if they:


  • Have at least one parent who is disabled or retired and eligible for Social Security benefits.
  • Have a parent who has passed away after working long enough to earn enough credits at a job where he or she has paid Social Security taxes.


The final core similarity between the two is the enrollment. Believe it or not, you must enroll for both programs through the Social Security Administration. On the SSA’s website, you can apply for retirement, disability, and Medicare benefits, as well as check the status your applications or appeals.


How one may affect the other

Although the two programs offer different things to recipients, there are a couple of ways in which the two programs work in tandem. Here are some examples:


  • If you’re already receiving Social Security, you will have automatic enrollment into Medicare Part B. You can receive Social Security benefit as early as 62, but you cannot enroll in Medicare until three months prior to your 65th birthday. So, if you began collecting your Social Security early, you will be enrolled into Medicare Part B when you are first eligible.
  • Medicare premiums can be deducted from your Social Security benefits. Part A of Medicare is free for most people, but you are expected to pay premiums for Part B, your medical coverage. However, you can deduct your Part B premium from your Social Security payment. Let’s say you receive $1,800 a month from Social Security, and your Medicare Part B premium is $200 a month. That means you will receive $1,600 as your payment.


Things to keep in mind

Many people confuse Medicare with Social Security, and it’s easy to do so. Noting the similarities and differences between the two is important to know because that core understanding will help you maximize your plans to your benefit. But there are also a few other things you need to keep in mind while you consider the relationship between the two.


First, you can begin your Social Security benefits anytime between 62 and 70. And, unlike Medicare, it’s encouraged – if you are healthy and able – that you receive your payments as close to 70 as you can, because that way, you will earn a higher paycheck. With Medicare, however, it is important to enroll during that initial enrollment period, which begins three months before you turn 65 and lasts until three months after you turn 65. Otherwise, you face permanent penalties.


You also want to keep in mind the fact that you do not have to be receiving Social Security benefits to enroll in Medicare, nor do you need to be enrolled in Medicare to receive Social Security benefits.


If you are not enrolled in Medicare, then it is important to determine what the important enrollment dates are. You are first eligible for Medicare when you are just about to turn 65. If you do not enroll during your initial enrollment period, then there is still time. You can enroll during the Annual enrollment Period, which is held annually from October 15 through December 7.

If you have any remaining confusion about how Social Security and Medicare share a relationship, let us help you. At The Best Senior Services, we specialize in educating seniors about programs that apply to them and their loved ones and connecting them to a local licensed agent who will help seniors get what they need at their best interest. Don’t delay any longer. Call us at 855.979.8277, or visit our website today.

Differences in Medicare Plans

Medicare is something you’ve heard about throughout your adult life. And if you’re approaching the age in which you can sign up, you’ve probably familiarized yourself with it a little bit more. Even if you’ve read just a few of our blogs, you’re pretty well-acquainted with Medicare. However, it’s one thing to know about Medicare, and what its basic functions are. But it’s a completely different thing to understand how Medicare will apply specifically to you.

That’s why The Best Senior Services (TBSS) is taking the time to explain the differences in Medicare plans so that you can spend less time worrying about what you need, and more time preparing for your needs.


Original Government Medicare (OGM)

The OGM plan is administered throughout the federal government. Within this plan, there are two parts: Part A and Part B. You’re probably familiar with both Parts, but for a quick refresher, let’s dive into what each offer.

Medicare Part A: Part A of your OGM plan is going to be hospital insurance. In other words, it covers in-patient hospital care, hospice care, nursing home care and more. You are eligible for Part A if you are at least 65 or if you have End-Stage Renal Disease (ESRD). For many Americans with Medicare, Part A is free. Well, kind of. Most people will get Part A for “free” if they (or their spouses) have been paying into Medicare taxes for a minimum of 10 years and/or have a specific number of quarters of coverage (QCs).

Now, this is where it gets tricky. According to Centers for Medicare and Medicaid Services, “the exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or ESRD.”

  • Medicare Part B: Part B of your OGM plan is going to be medical insurance. In other words, it covers out-patient medical care. According to Medicare.gov, this includes “medically necessary services” — like those that are used to diagnose you and/or treat you for an illness — and “preventive services” — health care that prevents an illness, or detect it at an early stage, when its treatment will be most effective.

    Unlike Part A, everyone will have to pay a monthly premium for Part B. However, how much an individual is required to pay will vary from person to person. Many people believe that this is based upon your location or what state you live in, but it’s actually based upon your income.

  • Medicare Part D (optional): Part D of your OGM plan is going to be prescription drugs. It is responsible for covering drugs that would otherwise be uncovered by Parts A and B.  Like Part B, individuals who have Part D will have to pay monthly premiums, as well as yearly deductibles, copays and the gap in coverage. Rates will also vary upon the individual.

    However, on the bright side, the federal government will fund 75% of the medication costs under Part D. According to Medicare.gov, how much you will owe on the coverage gap depends on:


  • “Your prescriptions and whether they’re on your plan’s list of covered drugs,
  • What ‘tier’ the drug is in,
  • Which drug benefit phase you’re in,
  • Which pharmacy you use,” and
  • Whether you utilize Medicare’s “Extra Help” program for paying for your drug coverage costs.
  • Medicare Supplement Plans (optional): Medicare Supplement plans, also known as Medigap, is designed to help individuals cover costs that otherwise would not be covered by their OGM (Original Government Medicare) plan. These costs could be along the lines of copayments, deductibles, or coinsurance. It is important to note that you may only enroll in a Medicare Supplement plan if you are enrolled in OGM, and no other Medicare plan.Medicare Supplement premiums are separate from Part B premiums, meaning the two must be paid for separately. Individuals with Medicare Supplement plans can pay for their monthly premiums through their private insurance provider.


Medicare Advantage (Medicare Part C)

As opposed to the Original Government Medicare plan, there is a Medicare Advantage plan that is offered to individuals. Also known as Part C, this plan is offered by private companies that have been approved by Medicare. Being a part of a Medicare Advantage plan will give you both Part A and Part B, as well as the optional Part D. However, an individual with Part C will be unable to enroll in Medigap.

Medicare.gov has laid out the different types of Medicare Advantage plans that you need to know about:


  • Health Maintenance Organization plans. In most Health Maintenance Organizations (HMOs), your plan will have a network. Within this network, you will have a list of doctors, hospitals, or health care providers in which your plan will be accepted. When you go outside of this network, services will not accept your plan. However, this network is not abided by when you are in an emergency situation. This means that, if you are out-of-network, and you are in an urgent situation or in need of dialysis, you will be able to seek services.
  • Preferred Provided Organization plans. Preferred Provided Organizations (PPO) allow you to pay less for specific services if you stay within your network. These services induce doctors’ visits, hospital visits and other health care services.
  • Special Needs Plans (SNPS). SNPs includes unique health care for a limited group of people. This limited group includes people with both Medicare and Medicaid, those who live in a nursing home, and/or those who are living with chronic medical conditions.
  • Private fee-for-Service plans. The Private fee-for-Service Plans (PFFS) allow you to go to just about any doctor, hospital and/or health care provider, just like you would be able to if you have the OGM plan. Your PFFS plan will help you determine how much it will be paying for these visits, and how much you will be paying when you go to these visits.
  • Medical Savings Account plans. Your Medical Savings Account plan (MSA) will combine a bank account with a “high-deductible health plan.” Medicare will deposit money into this account, and you will be able to use it to pay for your health care services. However, drug coverage is not offered by MSA plan. You will have to get Part D in order to acquire prescription drug coverage.


Essentially, you will find that a Medicare Advantage plan will cover most of what the OGM plan will cover, with exception to the hospice care. With Medicare Advantage plans, you will be covered for all types of emergency care. The only way in which you will be unable to receive these services while out-of-network is if you are no longer in the country.

A benefit that Medicare Advantage offers, that is not offered by Original Medicare, is dental and vision care, as well as wellness programs.

One thing that is important to note is that there is no “right” or “wrong” Medicare plan. It’s just a matter of what is the best plan for you and your loved ones. Each Medicare plan has a lot of benefits that are available to you, so it is worth exploring what options are available to you based off of your current location.

When you’re more familiar with Medicare, you feel more at ease about signing up for your plan. And The Best Senior Services can help with that too. If you have any more questions about the differences within Medicare plans, don’t hesitate to contact TBSS today. Not only do we educate seniors about Medicare and other financial services, but we also connect you with local licensed agents who are more than happy to answer any of your questions and walk you through your options. You can get started with us by visiting our website or calling us at 855.979.8277 today.


Are Your Medicare Supplement Rates Going Up?

Medicare Supplements, also known as Medigap, are subjective to having their rates change. In fact, if you’ve had a Medigap plan for at least a year, it’s likely that your premium has occasionally increased. If this stresses you out, don’t let it. It happens to everyone at some point.

The short answer to the question of, “Are your Medicare Supplements rates going up?” is yes. They are. But if you want to know why, and what you can do to prevent your rates from becoming crippling, then you don’t need to look any further.

This article will help explain why your rates are increasing, how to know they are going up, and what you can do about it. Let’s get started.


Why are rates increasing

There are a few reasons why your rates could be increasing. The first reasoning lies within the cost of healthcare as a whole. Like many other insurance services, healthcare can undergo inflation to its prices. In fact, it can even go through a deflation of its pricing, but that is a rare occurrence. So, as this change in pricing occurs, insurance companies have to mirror that in what they offer.

This can be mirrored through the concept known as “community-based pricing,” meaning that the price of your Medicare Supplement’s rates increases on account of inflation, utilization, and tobacco usage. A community-based pricing plan will have you spending the same amount on your rates as someone who is older than you, as well as someone who is younger than you are.

The second reasoning has to do with other things in relation to your demographic, such as where you live, what gender you are, how you pay for your rates and more. For example, depending on the state you live in, your rates could be different from a friend or relative who is living in a separate state. And because women tend to be healthier than men, it’s possible that women’s rates will be slightly less expensive than men. However, there are still other things that will impact what you will owe.

The third reasoning has to do with your age, it lets you know whether your rates are going up. Read further below to see how.


How to know if rates are going up

There is one sure-fire way to find out whether your rates are going up, and all it takes is knowing how old you are. A lot of Medicare Supplement plans are sold on what is called an “attained age pricing structure.” Essentially, it means that as your age increases, so will your rates.

So, basically, you can expect your rates to go up as you get older.

You can also expect your rates to be higher if you waited a longer time to sign up for a Medigap policy. For example, someone who has signed up for a Medigap policy at 65 will have lower rates than someone who has signed up at the age of 70. This is a concept known as “issue-age pricing,” in which the cost of your rates is based upon the age you are when you sign up.

However, you must keep in mind that policy plans will differ depending on the state you live in. Research your state’s laws online, or speak to a specialized agent, about Medigap pricing to see how you are charged for your policy.


How this can affect you

The great thing about Medicare Supplement policies is that it is designed to help you pay for the gap in coverage between your Medicare plan and prescription drug costs. This is especially helpful for those who would struggle to pay for that gap. But what happens if the increase in rates begin to get to be too much?

Some people are finding themselves in situations in which paying for Medigap premiums are becoming more difficult as the years go by. In these situations, it’s worth sitting down and looking over Medicare Supplements.

If you are in this situation, then there are some things you can do to reduce your costs. However, it is also recommended that you speak with your agent to determine what it is that you can do.


What you can do

Although it is inevitable that your rates will increase, that doesn’t mean you can’t do anything about it. One thing that you can do is switch Medigap policies. This is a common solution for many Americans who are looking to lower their Medicare Supplement premiums. However, it is important to know that once you switch to a new policy, you lose your old one and you cannot get it back.

You may also want to consider switching to a Medicare Advantage plan. The reasoning behind this could fall within both your health and your affordability. Because Medigap is linked to Medicare, you can sign up for a policy, or switch to a new one, during the annual enrollment period. However, in order to switch your Medigap policy, you will have to go through medical underwriting. This basically means that your medical history will be evaluated in order to ensure that you are actually able to switch. But let’s say that your health is deteriorating, and your medical underwriting is not approved for switching. If you can no longer afford your current Medigap policy, then it may just be time to switch to a Medicare Advantage plan, also known as Part C. However, this something you should think heavily on before switching. You will want to speak with an agent, who will provide you with advice, to make this is something you should do.

However, many Americans are happy with the Medicare Supplement plan that they already have, and they’re not looking to switch anytime soon. If that applies to you, then there are still options you have to manage these increasing costs:

  • Switch carriers. One thing to consider is simply switching Medicare Supplement carriers, which is something you can do while maintaining the same plan. Contact different agencies to see what their rates for Medigap are. If they’re significantly less than your current carrier, it may be worth switching over.However, it is important to know that there will always be uncertainty about how your carrier will increase its rates throughout the years. Increases to your Medicare Supplement rates are inevitable, so switching carriers with hopes that your rates will never raise again would be an act in futility.
  • Household discounts. These are a way to keep your plan and lower your rates at the same time. However, it requires at least one other person to be living in your household who is also eligible for Medigap. If you meet this criterion, you will want to know how you can utilize household discounts to lower your rates.Household discounts are Medicap deals in which your monthly Medicare Supplement rates will be discounted whenever there are two people enrolled within the same Medigap insurance agency living in a singular address. The percentage that would be discounted will not be the same for everyone, however. How much you receive off will be determined on your location (or state) and the Medicare Supplement carrier you are using.

    You will want to get in contact with your carrier to determine whether you qualify for a Household Discount or contact a local agent to objectively determine the benefits of this discount.


With inflation, age and other factors determining what your Medicare Supplement rates will be, you can find yourself in a confusing and overwhelming situation. Luckily, with the help of The Best Senior Services (TBSS), this doesn’t have to be the case. With TBSS, you have a guaranteed place to go if you are looking to learn more about Medicare and other financial services. In fact, if you have more questions that are based off of your specific needs, you can be connected with a local, licensed agent who will take the time to answer your concerns. You can visit our website or call us at 855.979.8277 to get started with us today.


How to Reduce Your Life Insurance Premiums

Although a life insurance plan is essential for your loved ones to be able to manage financially if something happens to you, the costs can be expensive and difficult to manage. Luckily, there are ways to reduce the cost of your life insurance premiums while still having the protection you need. The best way to start saving on your life insurance is to shop around for a policy. Premiums, as well as what is excluded from the policy, can vary greatly from company to company.

Make an estimate

Insurance is often confusing and many of the exclusions within policies are hidden. But it’s essential to know the exclusions before the policy needs to be claimed. If you don’t know them, you fall risk to paying premiums that you’re unable to claim. A specialist broker can do this for you. The amount of insurance you need will have to be considered. If you take too much, you will be paying more than necessary, but, if you don’t cover yourself for enough, your loved ones could lose out when it comes to claiming. In order to determine the correct amount, you should ask yourself how much money your loved ones would need in order to cover immediate expenses. Then, determine how much income your loved ones would need in order to sustain the household. This should give you a good starting point as to how much to insure your life.

Get help from a specialist

The next step in reducing your life insurance premiums is to seek help from a specialist. There are a couple of options you have when starting your search. The first option is to seek help from an independent life insurance broker who works closely with multiple insurance agencies. This broker will provide you with objective information and suggest quotes among the agencies. The broker will consider your needs before searching throughout different agencies to find your best deal. The second option is to seek an insurance agent who represents a single insurance company. This agent will have in-depth knowledge of the pricing and services that is within his or her company. Your third option is to visit The Best Senior Services (TBSS). At TBSS, we specialize in educating seniors about Medicare and other financial services because we care. We also connect seniors and their loved ones to local licensed agents who will discuss the options that are best for them.

Think about which option will suit you and your loved ones best and seek help with them toward reducing your life insurance premium.

Make some lifestyle changes

There are many benefits to leading a healthy lifestyle. Perhaps the most obvious benefit is that we look great and feel better. It also saves money on the cost of your life insurance. A great way to keep your insurance cost to a minimum is to keep yourself fit and healthy. This includes the basics: drink more water, eat healthier, cut back on your smoking and/or drinking and increase your exercise time. The reason a healthy lifestyle reduces the cost of your life insurance is because you are lowering your risk of getting some of the medical conditions that would raise your life insurance premiums. Some of these conditions include heart disease, obesity and heart disease. Think about it this way: when you lead a healthy lifestyle, you lower the risk of getting sick. So, when you apply for life insurance, you’ll present yourself as a low risk for the insurance company, which ultimately lowers your premium.

Doing this presents a win-win scenario for you. Not only are you healthier, but you’re also spending less on your life insurance premiums!


Certain conditions could mean that you would be better off going with a specialist insurer. This is because an insurer who specializes in certain conditions could save you money on your premium. If you and your partner are both looking to be insured, then taking out a combined policy could save you money on individual premium costs. This is also known as bundling. Bundling occurs when you purchase multiple policies from the same insurance provider. Insurance companies will offer discounts when you purchase more than one policy from them so, in the long run, you will be able to save more money than if you had different plans with differing companies. However. each person — or each couple — will have differing preferences when it comes to his or her premiums. That’s why it’s helpful to seek advice from a specialist who can help you personalize your premiums, so that you can determine what is best for you and your loved ones.

Utilize online resources

Sometimes, all it takes is an internet search to find great resources. These resources will give you tips on reducing your life insurance premium while also pointing you in the direction of an agency or an independent broker that is tailored to your needs. Not only that, but this is a convenient way of doing research. You are doing it on your own time, and you can get answers to the specific questions you are asking.

Ask for a reexamination if your health improves

Now that you’re aware of the fact that an improved health will reduce the cost of your life insurance premium, it’s important to be reexamined when you’re able to achieve that. It’s also important to note that different insurers will have differing policies in regard to your change. This means you may have to take a health exam. It could also mean your insurance agency will seek out updated medical records from your doctor. Whatever the case, it’s important to start making phone calls to see what is required so that you get to pay less on your premium.

Why this is important

Life insurance premiums can become costly based on what your needs are. Knowing you can reduce these costs is important. This is because there aren’t a lot of insurance premiums out there in which you can work toward lowering the payment costs. And doing what is needed to reduce the amount you own on your life insurance will allow you to focus on the things that you really care about, like your friends, family, passions, and hobbies


There are multiple ways in which you can lower the cost of your life insurance premium. It starts with evaluating what you have and researching ways to get started on saving. It’s important to at least consider taking the steps on how to reduce your premium costs, so that you’re benefitting yourself – and your loved ones – in the event that something happens to you. Once you begin to take these necessary steps to save on your premium, you’ll be glad you did.

If you have any other questions about your life insurance premiums, The Best Senior Services are here to help. You can get started today by visiting TBSS online or calling us at 855-979-8227.